Thursday, February 23, 2012

Over the next few weeks, we will be telling a series stories of alumni and current volunteers, staff, and board members who have worked with UVP. Jessica Suchy is our first individual to showcase.

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Jessica Suchy is originally from Maryland and graduated from the University of Maryland, College Park with a degree in Communication and citation in International Studies. After graduation, she worked in hospital revenue cycle consulting for several years. For the past two years, she’s been working towards her Masters in Public Health at the University of Pittsburgh and interned with UVP in 2011 as a practicum for her degree. She plans to return to Washington DC to work in program management and evaluation. Recently, as part of her coursework, she interviewed Alison Hayward, UVP's Director and one of its co-founders, about the obstetric fistula program.

Jessica: Please describe the work you currently do (and have done in the past) with the Uganda Village Project.

Alison: I first helped to found the Uganda Village Project in 2003, just after graduating from college. I traveled to eastern Uganda to perform a needs assessment with two other students. Having seen the desperate needs of the communities there, I began spending more and more time trying to build the organization to serve those communities. I took over as director in 2005. I have served in the assistant director or director role since then.

UVP's core program concept is called Healthy Villages. In this program, we include a variety of interventions aimed to address the needs of each rural community we work with. We are specifically targeting a group of villages identified with the assistance of the District Health Office as being the most deficient in sanitation measures, which is a proxy for poverty level. Interventions included in the Healthy Villages Program include mosquito net distribution and malaria prevention education, sanitation campaigns, HIV testing and counseling, family planning, construction of protected water sources, and formation of a team of community health workers called Village Health Teams. The formation of these teams is endorsed by the Ugandan government, and they serve as the main point of contact for a community and source of sustainability for the programs after the communities graduate from the 3 year program.

In addition, UVP also supports a scholarship program for secondary school and university students, and helps to facilitate referral networks for common diseases of poverty for which curative treatments are locally available, specifically, obstetric fistula and eye health (cataract surgery etc.).

Jessica: How would you describe the rural Ugandan population with whom you work?

Alison: They are amongst the happiest people I have ever met. Their continual joy for life is part of what makes visiting the area and learning from them about their culture and traditions so rewarding. They also can be challenging to work with, because of the huge cultural divide between my experience and theirs. I sometimes find it difficult to understand the motivations behind their behaviors and practices. I would also describe them as remarkably resilient. They think nothing of doing back-breaking labor for extended periods of time to achieve their goals, which is something that is uncommon in the United States.

Jessica: How would you describe the fistula patients? (i.e. demographic characteristics, their values, what's important to them, cultural factors, etc.).

Alison: The fistula patients are a heterogeneous group, so I think it is difficult to make sweeping generalizations about them. We have helped to facilitate fistula repair for women ranging from a 7 year old girl to women whose ages are unknown and listed as "elderly.” However, what they tend to share is that they are from poorer households and more rural communities. The less access they have to advanced healthcare facilities, the more likely they are to develop obstetric fistula, because they did not receive the prenatal care that identified them as high risk, or they had a prolonged and obstructed labor and were not able to access a location with the capability to perform a C-section until it was too late. Part of the accessibility issue is location and part of it is money. In Uganda, men tend to control the household finances, and they may not give their wives enough money to receive prenatal care or to give birth in a healthcare facility because they do not understand the value of it.

Fistula patients are under great pressure not to take time off from their household chores, farming, and family obligations. This is so much the case that they are willing to risk the success of their repair to go back home and start working again. We have to pay them to stay at the camp so that they can justify their absence. We also do a sensitization with the family and husband in particular to emphasize what needs to be done to try to keep the repair successful, such as no sexual intercourse for an extended time after the surgery, as the women are not in a position to say "no" to intercourse to their husbands.

I believe that despite our best attempts at social support, it is impossible for us to truly comprehend the suffering and emotional debility faced by fistula patients. This point was driven home about two years ago when a woman whose surgical repair had failed killed herself before we could get her back to the camp for another surgery.

Jessica: What challenges do you see in working with the Healthy Villages (as a whole), and fistula patients (in particular)?

Alison: Poverty is the root cause of most of the challenges, in part because poverty forces community members to prioritize their work over healthy practices and behaviors, and to try to 'save money' by not spending on necessary preventative healthcare or treatment for diseases, although in the end of course this can result in having to pay the ultimate cost.

With fistula patients, we are working with the most marginalized population of an already marginalized population. They have no power in society and their human rights have been steamrollered. We have to give them the best social support we can offer to try to get them through to a new life without fistula.

Jessica: How do you think these challenges can be addressed in the design of intervention programs targeted to this population?

Alison: The most important aspects of program design would be, in my opinion:

Maximize support of the patients during the process because of their vulnerability and lack of money or power, this includes as best it can be arranged, extended follow up after the repair to try to ensure that complications are dealt with appropriately, that post-surgical precautions are observed and understood, and that success rates of repair can be monitored.

Build capacity for continued programming locally, in terms of hospital resources and local physicians/medical officers/midwives and nurses.

Couple the repair intervention with community education so that community members understand the actual cause of obstetric fistula and that it can be cured, to eradicate myths and misconceptions.

Some people also put forth the idea that fistula repair programs should be coupled with income generation programs to provide financial and material support for the women after the repair. UVP has not extended into this area, although it's a great idea, but there are so many women (not just fistula patients) who need such a program and income generating programs venture away from our health-focused mission.

Jessica: Is there anything else you'd like to tell me about your work with UVP or the future of the fistula program?

Alison: I worry that the fistula program is in danger because the physicians who do the surgeries may leave. The British surgeons may retire, and the Ugandan physician has considered leaving Kamuli Hospital. Fistula care does not pay well and it is highly complex. Not enough local physicians are being trained or have any incentive to be trained in the surgery.

I also worry that patient rights need to be respected during the surgery process. Because of the power differential it is easy to forget that the patients still require privacy, respect, fully informed consent, etc. Because of this issue, for the past several camps we have been providing a Ugandan medical student as an interpreter for the patients, who also gets to observe and assist on the surgeries. I also was able to facilitate an American OB/GYN resident to rotate at Kamuli this year, and hoping to continue to facilitate visiting OB/GYN residents because I think they will help bring a good perspective on improving the experience for patients as well, and it's a fantastic experience for them.

And a question for Jessica -

UVP: What are you doing now, and how has UVP impacted your future career trajectory?

Jessica: Right now I'm completing my last semester at the University of Pittsburgh's Graduate School of Public Health to earn my MPH and am starting to look for jobs. I was really inspired by the time I spent in Uganda, both with the people I met in Bulamagi village, as well as my fellow interns. As a result of completing my practicum with UVP, I have focused my thesis on the empowerment of women in developing countries and am currently looking for jobs that involve backstopping and managing public health programs (specifically family planning and reproductive health) in Africa.

Tuesday, February 14, 2012

In July 2011, I had the happy privilege of holding the Uganda Village Project’s first ever Mojitos Against Mosquitoes event- a happy hour cocktail evening focused on raising awareness about UVP, health and development issues in Uganda, the unique issues of malaria prevention and control, and ways that people can become involved by donating time or money toward UVP’s efforts on the ground.

As a member of the Uganda Village Project’s executive board I am always looking for innovative ways to spread the word about UVP, and when our board came up with the idea for a “mojitos against mosquitoes” event several months ago it felt like the perfect time to try out my event planning skills. I live and work in Seattle, WA, and the presence of numerous global health and development organizations here made Seattle the perfect spot for our inaugural Mojitos Against Mosquitoes event. Many hours of planning and a few bumps in the road later (I had to google “procurement form” the first time a donor asked for one) the event came together and was a complete success. My initial idea for a small get together had grown into a fully fledged fundraising event, and was held on July 28th in a private space at the swanky BalMar bar.

Highlights of the evening included two special cocktails- the Mozzie Mojito and Quinine Quencher (with $1 from each drink going to UVP), a fantastic raffle, and a silent auction with 26 amazing prize packages! Thanks to our generous donors, everybody at the event was able to snack on delicious chocolate frozen custard from Peaks Frozen Custard and take home an African cookbook from the Pan African Market!

Speakers included Meg Kilcup, a current UVP trustee who spoke about her time in Uganda as a UVP intern, Dr. Jessica Miller, a scientist working on malaria vaccines at Seattle BioMed, and myself. Jones Mulgulusi from the Washington Basoga Association helped draw the raffle winners, and I was lucky enough to have Andrew Lowe (UVP’s treasurer and my fellow board member) and Bekah Walker (a past UVP intern) on hand to help out throughout the event. Professional photography was provided by White Hawk Images (check out the photos at our new facebook page here: http://www.facebook.com/pages/Uganda-Village-Project/251880514830749 )

"I’ve worked with a variety of non-profit organizations in the past in the efforts to provide care and education to those most in need. Many organizations have great intentions, but to me, it felt like we were simply putting a band-aid on problems instead of empowering the people to better their own lives and communities. Uganda Village Project does exactly that: empowers the communities that we work with so that even in the absence of UVP volunteers, the community members are educated and equipped to live a life as healthy as possible. For example, UVP strives to educate communities about how to prevent malaria, as well as the right actions to take when symptoms are present (such as go to the healthcare clinic and not the village witch doctor). If we simply offered malaria nets but didn’t empower those in the village to be able to make the right decisions if and when they are sick, we are only temporarily offering one solution and not a sustainable effort to prevent disease and/or mortality from disease."

-- Meg Kilcup, Current UVP trustee and former intern

Mojitos Against Mosquitoes had 75 guests and raised over $3000 for the Uganda Village Project, but I think that the most important outcome of the evening was the opportunity for people to get together and discuss health and development issues while finding out more about the Uganda Village Project. I plan to make Mojitos Against Mosquitoes an annual event, so maybe I’ll see you again this year!

UVP would like to thank the businesses that donated items for the raffle and auction.

Kathleen Bongiovanni serves as a Member at Large with UVP. She works as a Program Manager in the Center for Developmental Therapeutics at the Seattle Children’s Research Institute. She holds a Masters in Genetics and a Masters in International Public Health. Kathleen is passionate about global public health, and is always looking for opportunities to promote evidence based health and development programs and research.